| NPI | 1972163178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60756451) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P7855) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2023-04-18 |